Umbilical hernia

Disclaimer

These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Refer to the Emergency Department immediately if the hernia is incarcerated or there are signs of bowel obstruction.

Introduction

Umbilical hernias are common in babies and toddlers due to delayed closure of the umbilical cicatrix.

This presents as a soft lump with no redness or tenderness. Incarceration (hernia trapped in place) is rare and most umbilical hernias will close spontaneously by the age of 3 years.

Pre-referral investigations

Physical examination
Imaging is not indicated

Pre-referral management

Provide reassurance that umbilical hernias are common and most will close by age 3 years without treatment.

Although incarceration is rare in umbilical hernias, educate family of signs of bowel incarceration.

When to refer

Refer to the General Surgery Department when:

suspected omphalomesenteric duct remnant (failure of the duct to close and reabsorb once the umbilicus is formed in the foetus this may present as an umbilical mass, secretion from the umbilicus or appear as an umbilical polyp or granulation tissue)
patent urachus (failure of the embryonic link between the bladder and the umbilical cord to close and reabsorb this may present as intermittent leakage of urine from the umbilicus, periumbilical erythema, umbilical swelling, inflammation or infection).
there is difficulty in reducing hernia or if there is any discharge.
the umbilical hernia has not resolved by age 3.

How to refer

Routine non-urgent referrals from a GP or a Consultant should go to the Central Referral Service
Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals go to the PCH Referral Office
Urgent referrals (less than seven days) are made via the PCH Referral Office.

Essential information to include in your referral

Patient demographics including next of kin and contact details.
Physical examination report.

Useful resources

PCH Emergency Department Guidelines - Inguinal hernia
Health Pathways

References

Barreto L, Khan AR, Khanbhai M, Brain JL. Umbilical hernia. BMJ : British Medical Journal (Online). 2013 2013 Jul 19
2020-07-20;347. PubMed PMID: 1945810522. English.
Ireland A, Gollow I, Gera P. Low risk, but not no risk, of umbilical hernia complications requiring acute surgery in childhood. Journal of Paediatrics and Child Health. 2014;50(4):291-3.
Sherman JM, Rocker J, Rakovchik E. Her Belly Button is Leaking: A Case of Patent Urachus. Pediatric Emergency Care. 2015;31(3):202-4.
Solomon-Cohen E, Lapidoth M, Snast I, Ben-Amitai D, Zidan O, Friedland R, et al. Cutaneous presentations of omphalomesenteric duct remnant: A systematic review of the literature. Journal of the American Academy of Dermatology. 2019;81(5):1120-6.

Reviewer/Team:	Dr Parshotam Gera	Last reviewed:	May 2021
		Review date:	May 2024
Endorsed by:	CPAC	Date:	May 2021

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